Varicocele: Concerns About Fertility and Diagnosis

Q: Varicocele: Concerns About Fertility and Diagnosis

Hello Boy： 1. <br>The most basic requirement for normal fertility is having sufficient sperm. <br>Therefore, to address your concerns, a semen analysis can determine whether you meet this basic requirement. <br>However, meeting the basic requirement does not guarantee 100% fertil

Varicocele

I have some questions I would like to ask.
About two years ago, I underwent surgery for a left inguinal hernia.
Since the surgery, I have noticed that there seems to be a bit more tissue on the upper left side of my scrotum (possibly remnants of the hernia sac).
Sometimes, I feel my intestines moving (bloating), and it seems to move along with it.
I am concerned that this might affect my fertility.
1.
How can I be assured that my fertility is normal? If I consult a doctor about this issue, what kind of examinations would a typical physician perform? I previously visited a doctor and mentioned this concern, but they only performed a brief examination, stating that the hernia sac should have been removed.
They palpated the upper left side of my scrotum and mentioned that they did not feel any significant varicocele, but did not clearly state that there was no varicocele.
2.
Is a varicocele only located in the upper part of the scrotum, specifically above the testicle (on either side)? Is it possible for it to be located below the testicle? I can feel a larger blood vessel beneath my left testicle, while there is none on the right side.
The previous doctor did not address this aspect.
3.
I have heard that simply observing the external appearance may not be sufficient to diagnose a varicocele.
What type of examination would be more accurate, how much would it cost, and how long would it take to get the results? Would it be very complicated?
4.
Based on your opinion, which department should I consult, and what specific tests should I undergo? Thank you very much!

Boy, 20~29 year old female. Ask Date: 2005/01/18

Dr. Lin Hexing reply Urology

Hello Boy: 1.
The most basic requirement for normal fertility is having sufficient sperm.
Therefore, to address your concerns, a semen analysis can determine whether you meet this basic requirement.
However, meeting the basic requirement does not guarantee 100% fertility, as it is also important to consider whether the female partner is normal and if there are any special antibody rejections between both partners.
2.
The term "varicocele" refers to the abnormal enlargement of the veins within the spermatic cord, and there can be varying degrees of severity.
In your case, there is currently no significant varicocele present.
3.
In terms of examination, if varicocele cannot be detected while standing and performing a Valsalva maneuver (holding the breath and increasing abdominal pressure), then there is no significant varicocele issue.
Only if the semen analysis reveals poor sperm concentration, motility, or appearance would it be necessary to consider a scrotal Doppler ultrasound.
For the cost of this test, you would need to consult a medical center that offers it.
4.
I recommend that you visit a urology clinic for further evaluation.

Reply Date: 2005/01/18

More Info

Understanding varicocele and its potential impact on fertility is crucial for men who are concerned about their reproductive health. Varicocele refers to the enlargement of veins within the scrotum, similar to varicose veins that occur in the legs. This condition can affect sperm production and quality, leading to fertility issues. Here’s a comprehensive overview addressing your concerns and questions.

1. Assessing Fertility Function: To evaluate your fertility, a healthcare provider will typically start with a physical examination, which may include a scrotal ultrasound to assess for varicocele and other abnormalities. A semen analysis is also essential; it measures sperm count, motility (movement), and morphology (shape). These tests will provide a clearer picture of your fertility status. If you have concerns about your fertility, it’s advisable to consult a urologist or a reproductive endocrinologist who specializes in male fertility.

2. Location of Varicocele: Varicocele primarily occurs in the veins above the testicle, but it can also be present in other areas. While it is most commonly found on the left side due to anatomical differences in venous drainage, it can occur on the right side or bilaterally. If you feel larger veins beneath the left testicle, it may indicate the presence of a varicocele. However, not all enlarged veins are symptomatic of varicocele, and a thorough examination is necessary to confirm the diagnosis.

3. Diagnostic Tests: The most accurate way to diagnose varicocele is through a Doppler ultrasound, which assesses blood flow in the veins. This non-invasive test can help visualize the veins and determine if they are enlarged. The cost of a Doppler ultrasound can vary depending on your location and healthcare provider, but it typically ranges from $200 to $500. Results are usually available within a few days. In some cases, a urologist may recommend a venogram, which is more invasive and involves injecting a contrast dye into the veins to get detailed images.

4. Recommended Specialists and Tests: You should see a urologist who specializes in male reproductive health. They can perform the necessary examinations and recommend appropriate tests. In addition to a physical exam and ultrasound, they may suggest blood tests to check hormone levels, including testosterone, which can also impact fertility.

5. Addressing Your Concerns: If you have had previous surgeries, such as for a hernia, it’s essential to mention this to your doctor, as it could influence your current condition. The presence of a residual hernia sac may not directly affect fertility, but it’s worth discussing with your healthcare provider.
6. Next Steps: If you’re feeling anxious about your fertility, it’s important to take proactive steps. Schedule an appointment with a urologist who can provide a comprehensive evaluation. Be prepared to discuss your medical history, any symptoms you’ve experienced, and your concerns about fertility.
In conclusion, while varicocele can potentially affect fertility, many men with this condition can still conceive. Early diagnosis and appropriate management are key. Don’t hesitate to seek a second opinion if you feel your concerns are not being adequately addressed. Understanding your reproductive health is vital, and taking these steps can help you gain peace of mind regarding your fertility.

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